Tillou X, Demailly M, Hakami F, Westeel P-F, Saint F, Petit J
Service d'Urologie et Transplantation Rénale, CHU Sud, Ave René Laennec, 80054 Amiens CEDEX 1, France.
Transplant Proc. 2009 Oct;41(8):3314-6. doi: 10.1016/j.transproceed.2009.08.036.
To evaluate the epidemiology, diagnosis, and outcome of de novo renal cell carcinoma in renal transplant recipients.
From June 1989 to August 2006, 800 renal transplant recipients were followed up annually by a urologist using abdominal ultrasonography or computed tomography. Renal lesions considered suspect were treated using extended nephrectomy. Incidence, diagnosis, histologic type, treatment, and outcome were analyzed in all patients.
Thirty-three patients underwent nephrectomy because of suspect renal lesions including 22 de novo tumors in 21 native kidneys (renal clear-cell carcinoma in 15 and papillary carcinoma in 7). All tumors were classified as pT1aN0M0. Mean (range) time after diagnosis was 25.6 (2.3-105.5) months. Only 1 patient died, at 8 months after diagnosis. All other patients were alive at follow-up of 34.8 (2.8-113.9) months. Five-year survival was 92%.
The increased risk of tumor in renal transplant recipients leads us to propose extended nephrectomy in the case of suspect lesions in the native kidney. In our patients, 65% of patients had malignant lesions. Good prognosis for these localized tumors justified aggressive therapy even though 35% of transplant recipients were tumor-free.
评估肾移植受者新发肾细胞癌的流行病学、诊断及预后情况。
1989年6月至2006年8月，800例肾移植受者每年由一名泌尿科医生采用腹部超声或计算机断层扫描进行随访。对可疑的肾脏病变采用根治性肾切除术治疗。分析所有患者的发病率、诊断、组织学类型、治疗及预后情况。
33例患者因可疑肾脏病变接受了肾切除术，其中21例患者的22个原发肿瘤（15例为肾透明细胞癌，7例为乳头状癌）。所有肿瘤均分类为pT1aN0M0。诊断后的平均（范围）时间为25.6（2.3 - 105.5）个月。仅1例患者在诊断后8个月死亡。所有其他患者在34.8（2.8 - 113.9）个月的随访时仍存活。5年生存率为92%。
肾移植受者肿瘤风险增加，促使我们建议对原发肾可疑病变行根治性肾切除术。在我们的患者中，65%的患者有恶性病变。尽管35%的移植受者无肿瘤，但这些局限性肿瘤的良好预后证明积极治疗是合理的。
